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JNCI Journal of the National Cancer Institute 1993 85(22):1819-1827; doi:10.1093/jnci/85.22.1819
© 1993 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 85, No. 22, 1819-1827, November 17, 1993
© 1993 Oxford University Press

Migration Patterns and Breast Cancer Risk in Asian-American Women

Regina G. Ziegler, Robert N. Hoover, Malcolm C. Pike, Allan Hildesheim, Abraham M. Y. Nomura, Dee W. West, Anna H. Wu-Williams, Laurence N. Kolonel, Pamela L. Horn-Ross, Jeanne F. Rosenthal, Marianne B. Hyer

Environmental Epidemiology Branch, Division of Cancer Etiology, National Cancer Institute Bethesda, Md.
Department of Preventive Medicine, University of Southern California School of Medicine Los Angeles
Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii Honolulu
Northern California Cancer Center Union City
Westat, Inc. Rockville, Md.
Information Management Services, Inc. Rockville

Correspondence to: Regina G. Ziegler, Ph.D., Environmental Epidemiology Branch, National Cancer Institute, Executive Plaza North 443, Bethesda, MD 20892.

Background: Breast cancer incidence rates have historically been 4–7 times higher in the United States than in China or Japan, although the reasons remain elusive. When Chinese, Japanese, or Filipino women migrate to the United States, breast cancer risk rises over several generations and approaches that among U.S. Whites. Purpose: Our objective was to quantify breast cancer risks associated with the various migration patterns of Asian-American women. Methods: A population-based, case-control study of breast cancer among women of Chinese, Japanese, and Filipino ethnicities, aged 20–55 years, was conducted during 1983–1987 in San Francisco—Oakland, California, Los Angeles, California, and Oahu, Hawaii. We successfully interviewed 597 case subjects (70% of those eligible) and 966 control subjects (75%). Results: A sixfold gradient in breast cancer risk by migration patterns was observed. Asian-American women born in the West had a breast cancer risk 60% higher than Asian-American women born in the East. Among those born in the West, risk was determined by whether their grandparents, especially grandmothers, were born in the East or the West. Asian-American women with three or four grandparents born in the West had a risk 50% higher than those with all grandparents born in the East. Among the Asian-American women born in the East, breast cancer risk was determined by whether their communities prior to migration were rural or urban and by the number of years subsequently lived in the West. Migrants from urban areas had a risk 30% higher than migrants from rural areas. Migrants who had lived in the West for a decade or longer had a risk 80% higher than more recent migrants. Risk was unrelated to age at migration for women migrating at ages less than 36 years. Ethnic-specific incidence rates of breast cancer in the migrating generation were clearly elevated above those in the countries of origin, while rates in Asian-Americans born in the West approximated the U.S. White rate. Conclusions: Exposure to Western lifestyles had a substantial impact on breast cancer risk in Asian migrants to the United States during their lifetime. There was no direct evidence of an especially susceptible period, during either menarche or early reproductive life. Implications: Because heterogeneity in breast cancer risk in these ethnic populations is similar to that in international comparisons and because analytic epidemiologic studies offer the opportunity to disentangle correlated exposures, this study should provide new insights into the etiology of breast cancer. [J Natl Cancer Inst 85:1819–1827, 1993]



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L.-J. W. Lu, K. E. Anderson, J. J. Grady, F. Kohen, and M. Nagamani
Decreased Ovarian Hormones during a Soya Diet: Implications for Breast Cancer Prevention
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T. A. Lallas, S. K. McClain, M. S. Shahin, and R. E. Buller
The Glutathione S-Transferase M1 Genotype in Ovarian Cancer
Cancer Epidemiol. Biomarkers Prev., June 1, 2000; 9(6): 587 - 590.
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S. S. Coughlin and R. J. Uhler
Breast and Cervical Cancer Screening Practices among Asian and Pacific Islander Women in the United States, 1994-1997
Cancer Epidemiol. Biomarkers Prev., June 1, 2000; 9(6): 597 - 603.
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C. A Lamartiniere
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Am. J. Clinical Nutrition, June 1, 2000; 71(6): 1705S - 1707.
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E. Velie, M. Kulldorff, C. Schairer, G. Block, D. Albanes, and A. Schatzkin
Dietary Fat, Fat Subtypes, and Breast Cancer in Postmenopausal Women: a Prospective Cohort Study
J Natl Cancer Inst, May 17, 2000; 92(10): 833 - 839.
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L. Wroblewski Lissin and J. P. Cooke
Phytoestrogens and cardiovascular health
J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1403 - 1410.
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F. L.Martin, K. J.Cole, D. Harvey, G. Weaver, J.A. Williams, B. C.Millar, D. H.Phillips, and P. L.Grover
DNA damage in human breast milk cells and its induction by ‘early’ and ‘late’ milk extracts
Carcinogenesis, April 1, 2000; 21(4): 799 - 804.
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L.-J. W. Lu, M. Cree, S. Josyula, M. Nagamani, J. J. Grady, and K. E. Anderson
Increased Urinary Excretion of 2-Hydroxyestrone but not 16{{alpha}}-Hydroxyestrone in Premenopausal Women during a Soya Diet Containing Isoflavones
Cancer Res., March 1, 2000; 60(5): 1299 - 1305.
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G. Maskarinec, C. L. Y. Chan, L. Meng, A. A. Franke, and R. V. Cooney
Exploring the Feasibility and Effects of a High-Fruit and -Vegetable Diet in Healthy Women
Cancer Epidemiol. Biomarkers Prev., October 1, 1999; 8(10): 919 - 924.
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Role of Dietary Fat in the Causation of Breast Cancer: Point
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D. M. Tham, C. D. Gardner, and W. L. Haskell
Potential Health Benefits of Dietary Phytoestrogens: A Review of the Clinical, Epidemiological, and Mechanistic Evidence
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Environment and Cancer: Who Are Susceptible?
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Anthropometry and Breast Cancer
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